Clinical investigation: congestive heart failureScreening for left ventricular systolic dysfunction among patients with risk factors for heart failure☆
Section snippets
Study population
This study was approved by the MetroHealth Medical Center Institutional Review Board. Patients were recruited from the General Medicine and Geriatric clinics at MetroHealth between March 1998 and June 2000. Eligibility criteria included age ≥60 years; a history of hypertension, diabetes, or coronary artery disease (CAD, including prior myocardial infarction (MI), angina, or revascularization procedure); and no history of heart failure or documented reduced left ventricular ejection fraction
Results
Of the 1809 patients screened for the study, 78 (4.3%) refused to be interviewed and 760 (42.0%) were ineligible because they lacked risk factors for heart failure or they had a previous history of heart failure. Of the 971 eligible patients, 510 participated (51.6%). The average time (±SD) to complete the screening echocardiogram was 6.5 (±3.0) minutes. Of the 510 participants, 28 (5.5%) were excluded because prior heart failure or low LVEF was documented in their chart. Only one patient was
Discussion
Screening patients at high risk for development of heart failure with a limited echocardiogram is feasible and identifies a significant number of patients with LVSD. Patients with a past history of MI and those with definite or probable LVH by electrocardiography are particularly at risk. Patients with CAD who had not had a previous MI and those with a history of stroke were also had a higher risk of LVSD, but these trends did not reach statistical significance. Our ability to determine
Acknowledgements
We would like to thank Miriam Palmer, Annitta Morehead, Dr James Thomas, and the cardiac sonographers at MetroHealth Medical Center.
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Cited by (34)
Prevalence of asymptomatic left ventricular systolic dysfunction in at-risk medical inpatients
2013, American Journal of MedicineRoutinely adding ultrasound examinations by pocket-sized ultrasound devices improves inpatient diagnostics in a medical department
2012, European Journal of Internal MedicineCitation Excerpt :In a hypertensive population 6.5% of the patients had AAA [24]. Baker et al. screened patients with previous myocardial infarction and found that 15.4% had left ventricular ejection fraction < 45% [23]. An argument against screening may be incidental findings (IF).
Natriuretic Peptides
2007, Journal of the American College of CardiologyCitation Excerpt :However, large-scale studies are needed to evaluate the incremental value and cost-effectiveness of using NPs in this setting. Screening populations at high risk for development of HF, such as diabetic and elderly patients, and referring those with elevated NP levels for echocardiogram might in fact prove cost-effective despite the higher prevalence of elevated NP levels in these populations (119,120). Heidenreich et al. (120) recently found that using a BNP cutoff level of 24 pg/ml for echocardiogram referral was a cost-effective means of screening for LV dysfunction in populations (such as men over age 60 years and possibly women over age 60 years) with a prevalence of LV systolic dysfunction of at least 1%.
Prevalence and prognosis of left ventricular systolic dysfunction in asymptomatic diabetic patients without known coronary artery disease referred for stress single-photon emission computed tomography and assessment of left ventricular function
2007, American Heart JournalCitation Excerpt :Population-based screening studies generally have not focused on only diabetic subjects. Such studies reported varying and generally lower estimates (3.7%-14.9%) of reduced LVEF but included a mixture of subjects with and without cardiac symptoms, known CAD, and diabetes.15-21 The highest prior prevalence estimate in diabetic patients (14.7%) was reported by the Echocardiographic Heart of England screening study, where investigators used a cutoff LVEF of 50% and included both symptomatic and asymptomatic diabetic subjects with and without known CAD.19
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This project was supported by grant 9740079N from the American Heart Association.